Native Americans Pay High Cost for Health Care 

By Houkje Ross


Closing the Gap, The Problem of Accessing Health Care • August/September 1999


One of the largest barriers to health to provide the AI/AN population with ad­ surance. The cost for urban and all other 

care for American Indian and Alaska equate health care based on typical health Indians is $3 billion, of which IHS apNatives (AI/ANs) has been a lack benefits, such as doctors and hospital care, propriations provides less than $30 milof adequate federal funding, according to the according to Cliff Wiggins, Senior Opera­ lion. No data exist to estimate the third 

National Indian Health Board (NIHB). “De­ tions Research Officer at IHS. party contributions for these populaspite new technological advances, Indian “This does not include the larger health tions. IHS is reviewing the report and 

people are suffering and dying premature programs that are extremely important to will receive feedback from the Office of 

deaths, due in large part to under funding of Indian people, such as the sanitation, safe Management and Budget. 

the Indian Health Service,” said Buford L. water, and public health programs,” Wiggins For additional information about the reRolin, Chairman of NIHB, before the U.S. said. port or the services of IHS, contact: IHS, Public 

Senate Committee on Indian Affairs this past The study found that it would cost ap­ Affairs Office, 301-443-3593, or visit their 

summer. Rolin spoke in support of S. 299, a proximately $2,900 per person to provide Web site at www.ihs.gov.

bill that would elevate the Director of Indian Indian people with the health care services 

Health Service (IHS) to Assistant Secretary found in typical, mainstream health insurfor Indian Health. ance plans. Researchers determined this numA federal agency within HHS, the IHS ber by starting with a benchmark figure of 

provides health services to roughly 1.5 mil­ $2,100 per person, determined by averaglion AI/ANs who belong to more than 557 ing a range of three independent sources of 

federally recognized tribes and live on reser­ private health care premiums for the nonvations in 34 states. For many AI/ANs, the elderly.That figure was then adjusted for the 

Indian health care system—a partnership of cost of co-payments and deductibles, and for 

federal, tribal, and urban Indian operated the costs associated with the elderly. The tohealth care programs—is their only source of tal cost was then $3,391 per person. This is 

health care services. the total expected cost per person if the charThe federal funding that is provided acteristics of Indian people were the same as 

for the Indian health care system fulfills the for the U.S. general population. 

government’s treaty obligations to the tribes. The costs for Indians was then revised 

to account for the ways the Indian populaEstimating level of need tion differs from the general U.S. population. A younger and significantly rural InThe Indian health care system depends dian population lowered the costs, while a 

on annual discretionary appropriations. A higher incidence of disease and medical condefined package of health care services is not ditions raised the cost. 

assured to eligible Indians who need services. 

The level of services provided by the Indian Other findings: 

health care system varies depending on funding. According to part one of a Congression­ •	 A mainstream package of health care serally mandated study, Level of Need Funded vices for all 2.4 million AI/AN would 

Cost Model — Indian Health Service, the cost $7.4 billion. 

IHS appropriation provides only 59 percent 

of the necessary funding for the Indian health •	 The cost for mainstream services for the 

system. Raising that percentage one point IHS/tribal user population, 1.34 milwould cost $30 million. The cost to raise the lion AI/AN, would cost $4 billion. Aplevel of needed funds to 100 percent for the proximately 25 percent of this would 

IHS/Tribal user population is $1.2 billion. be expected from third party payers such 

The study looked at what it would cost as Medicare, Medicaid, and private inIHS Services 

The IHS administers health services in 

three ways: through IHS facilities, through 

tribally-operated facilities, and by contracting out for health services. IHS’s services 

include: 

•	 preventive health services to help reduce the need for acute medical care; 

•	 emergency medical services, where a 

community health representative responds within 15 minutes; 

•	 environmental health and engineering 

services that address the environmental 

conditions that contribute to morbidity and mortality among AI/ANs; 

•	 pharmacy services; 

•	 health education program to help AI/ 

ANs live healthier lifestyles; 

•	 community-based programs to combine the principles of public health 

with traditional medicine; 

•	 alcohol and substance abuse programs; 

•	 diabetes and nutritional programs; 

•	 school-based programs; 

•	 mental health programs that take into 

account traditional Indian ways of life, 

philosophy, and languages; 

•	 community health representative programs that train AI/ANs to become 

paraprofessionals through IHS, but they 

are employed and supervised by their 

tribes and communities; 

•	 dental programs; and 

•	 accident/ injury reduction 

programs. 

Office of Minority Health Resource Center	 U.S. Department of Health and Human Services